Obamacare at one year: a birthday assessment

One year later, can anyone really claim Obamacare isn't working?

The Affordable Care Act, or Obamacare, was signed into law on March 23, 2010. Some provisions went into effect by the end of that year and some over the following three years.

But by popular perception, the act kicked in last Oct. 1, when enrollment for individual insurance plans via the federal and state exchanges opened nationwide. For all intents and purposes, then, Wednesday was Obamcare's first birthday. How's it doing?

The inescapable answer is: very well, thank you. This will disappoint the legions of politicians and pundits, chiefly Republicans and conservatives, who became heavily invested in the act's failure--so heavily that where they couldn't point to tangible evidence of failure, which was most of the time, they resorted to distortion, outright fabrication and obstructionist legal strategies. Yes, the federal enrollment website, HealthCare.Gov, was a botch at the beginning. It has since been fixed, and federal enrollments ended up outpacing even the original, pre-botch, expectations.

We've devoted reams of copy to exploding the cherished myths of the Obamacare meltdown. Suffice to say that the failure of Obamacare has turned out to be a bad investment indeed. Several Republican governors, having squeezed all the ideological mileage they could from undermining the act, leaving their own most vulnerable citizens more impoverished and sick, recently have thrown in the towel, moving to expand Medicaid after months of stupid and spendthrift resistance. You can make money today betting that more will follow.

It's proper now to examine the tangible evidence that Obamacare has improved the lives of millions of Americans, in exactly the way its drafters expected. See the accompanying graphics for more. 

1. The ACA has sharply reduced the number of uninsured Americans. Gallup reported in July that the uninsured rate for adult Americans of 13.4% was the lowest it had recorded since it began measuring the rate in 2008. "This downward trend in the uninsured rate coincided with the health insurance marketplace exchanges opening in October 2013, and accelerated as the March 31 deadline to purchase health insurance coverage approached -- and passed -- for most uninsured Americans." The trend continued through the April 15 extended deadline for 2014 enrollment.

Gallup's findings are supported by results from the Commonwealth Fund, Rand Corp. and the Urban Institute. The last of these found, notably, that the rate dropped especially sharply among states that have expanded Medicaid under the ACA--hardly a surprise, since that provision, shunned by many Republican state governments, specifically addressed lack of insurance among the poorest Americans.

2. The ACA has materially cut hospital outlays for uncompensated care. The Department of Health and Human Services says these costs will be $5.7 billion less in 2014, a 16% drop, than they would have been without the law. The agency attributes the change to an estimated decrease of 10.3 million uninsured persons, and an increase of 8 million in Medicaid rolls. Its estimate of costs is based partially on reports from hospital companies, which have found huge reductions in the volume of uninsured admissions; at Tenet Healthcare, a nationwide hospital chain, uninsured admissions dropped 33% in the first quarter of 2014 compared to a year earlier.

3. The ACA has allowed thousands of workers to voluntarily reduce their work hours to care for children or elderly parents, or to explore new opportunities. On this basis the Center for Economic and Policy Research calls the ACA "a family-friendly policy." 

CEPR observes that the 2.1% increase in voluntary part-time employment--an average monthly rise of nearly 400,000 workers to 19.5 million in the first half of 2014, compared to a year earlier, can be accounted for entirely by an increase of women working voluntary part-time hours.

The increase is especially pronounced among workers aged 16-35 with children (11.3% increase) and even more so among young workers with three children or more (15.4%).

It's worth noting that evidence that the ACA has sparked an increase in involuntary part-time employment, as employers try to evade the law's coverage requirements, remains nonexistent. The law's critics, including the Koch interests, have resorted to bogus numbers to sustain this assertion, but that merely underscores how threadbare it is.

5. The rate of growth in healthcare costs has slowed. "Sticker shock," a sharp increase in premiums so assiduously and consistently predicted by the ACA's critics, simply hasn't materialized. In fact, the Kaiser Family Foundation reported last month that the average change in premiums for benchmark silver tier plans will be a reduction next year compared to 2014.

Meanwhile, more insurers are flowing into the exchange marketplace. According to preliminary data compiled by HHS, there will be a 25% increase in health insurance issuers next year, nationwide. Four of the 36 states in the federal marketplace will have at least double the number of insurers next year compared to 2014. Insurers who held back in 2014 to see how the exchange market shook out have evidently decided that things look OK: "Some of the nation's largest issuers will be offering coverage for the first time in more than a dozen states," HHS says.

Is the ACA perfect? Of course not, but that's hardly the proper standard to apply to a law that dramatically reshapes the healthcare landscape. In its one-year report card, the Commonwealth Fund gave a "needs improvement" grade to the online exchange enrollment experience, based on its finding that 62% of enrollees were still rating the websites fair or poor, even as late as June.

But the fund gave the act "good to excellent" grades for its having enrolled some 15.3 million people in marketplace plans or Medicaid by mid-August and for its reduction in the uninsured rate.

On the question of whether Americans were using their new insurance to get treatment, the Commonwealth Fund gave the ACA "extra credit": according to a survey the fund conducted in April, May and June, 60% of people who had new coverage had already used it to obtain healthcare. "People with new coverage appear to be getting the doctors they want and getting appointments with wait times consistent with U.S. averages."

That is, of course, the ultimate goal of the Affordable Care Act, and it's meeting the goal. The signs are that America's old system of health coverage, which relied on employer-sponsored care and condemned those without it to enormous premiums, to uninsurability, and to unmet medical needs, is being supplanted by a new system in which coverage is available to everyone at a reasonable and affordable price, no one needs to feel trapped in a job merely for the insurance, and the prospect of medical bankruptcy will recede over time.

There remain holdouts who complain that the ACA is an infringement of "freedom." That's true only under a bizarro-world definition of "freedom." Before the ACA, Americans were "free" to be locked into jobs they detested; to be abused, ripped off or rejected outright by insurance companies; and to suffer medical conditions without treatment.

The ACA hasn't changed every aspect of that in a single year, and its ability to meet all of its goals remains conjectural. But so far it has pointed the way to a better--yes, radically better--system of American healthcare.

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